【摘要】 目的:研究深圳妇女改良巴氏涂片联合HC-Ⅱ法HPV筛查宫颈癌的应用前景。方法:2012年2月至2012年7月对深圳市3年内从未行宫颈癌筛查的30~59岁的1000名妇女进行子宫颈癌筛查。单数妇女行改良取样巴氏涂片(Pap)(采用液基细胞学刷取样)和HC-Ⅱ法HPV检测;双数妇女行薄层液基细胞学(LCT)和HC-Ⅱ法HPV检测。对细胞学结果≥不典型鳞状细胞(ASCUS)或HPV检测阳性者行阴道镜下多点活检,以病理为金标准评价各种宫颈癌筛查方案的价值,研究改良巴氏涂片联合HPV筛查方案的性价比。结果:本次筛查Pap阳性50例;LCT阳性57例;高危型HPV阳性200例。213例取病理:CINⅠ(含HPV感染)97例,CINⅡ23例,CINⅢ37例,宫颈癌3例,慢性宫颈炎和鳞状上皮化生40例。改良Pap的灵敏度、特异度、阴性预测值及约登指数分别是63.2%、94.43%、96.9%及0.58;LCT以上相应指数分别是76.0%、92.0%、98.7%及0.64;HC-Ⅱ法HPV的相应指数分别是96.8%、85.0%、98.5%及0.82;改良Pap联合HC-Ⅱ法HPV平行试验的相应指数分别100.0%、83.3%、100.0%及0.83;LCT联合HC-Ⅱ法HPV平行试验的相应指数分别是100.0%、83.2%、100.0%及0.83;改良Pap联合HC-Ⅱ法HPV系列试验的相应指数分别60.5%、95.9%、96.7%及0.56;LCT联合HC-Ⅱ法HPV系列试验的相应指数分别是72.0%、94.3%、98.5%及0.66。不同筛查试验受试者工作特征(receiver operating characteristic,ROC)曲线下面积分别为Pap 0.788、LCT 0.840、HPV 0.910、Pap-HPV平行0.917、LCT-HPV平行0.916、Pap-HPV系列0.782、LCT-HPV系列0.832。Pap-HPV平行试验筛查宫颈癌ROC曲线面积最大。改良巴氏涂片的筛查宫颈癌的效价比最高。结论:改良Pap联合HC-Ⅱ法HPV平行试验对深圳妇女宫颈癌筛查具有最大的应用前景。更多还原

【Abstract】 Objective: To study the prospect of apply improved papanicolaou smear( Pap) by improved take-samples and high-risk human papillomavirus detection for Shenzhen women cervical cancer screening.Method: Conventional Pap smear by improving take-samples and hybrid capture Ⅱ human papillomavarus( HC-ⅡHPV) test were performed in odd number women,LCT and HC-ⅡHPV test were performed in even number women,Total 1000 women in study with 30 ~ 59 years old no any cervical screening in 3 yeals in Shenzhen from Feb. 2012 to Jul. 2012. The women with HPV-positive,Pap≥ atypical squamous cells of undetermined sign( ASCUS) or LCT≥ASCUS received multi- spot biopsy under colposcopy. Result: In the study,Pap-positive,LCT-positive and HPV-positive were 50,57 and 220 cases,respectively. A total of213 women received biopsy in the study. 97 cases had cervical intraepithelial neoplasia( CIN) Ⅰ,23 cases had CINⅡ,37 cases had CINⅢ,3 cases had cervical cancer,40 cases had chronic cervititis and metaplasia.The sensitivity,specificity,negative predicted value,Youden ’ s index of Pap was 63. 2%,94. 43%,96.9%,0.58,respectively.The corresponding index of LCT was 76.0%,92.0%,98.7%,0.64,respectively. The corresponding index of HPV was 96.8%,85.0%,98.5%,0.82,respectively. The corresponding index of Pap-HPV parallel test was 100.0%,83.3%,100.0%,0.83 respectively. The corresponding index of LCT-HPV parallel test was 100.0%,83.2%,100.0%,0.83,respectively. The corresponding index of Pap-HPV parallel test was 60.5%,95.9%,96.7%,0.56,respectively.The corresponding index of Pap-HPV serial test was 72.0%,94.3%,98. 5%,0. 66,respectively. The receiver operating characteristic( ROC) of Pap,LCT,HPV,Pap-HPV parallel test,LCT-HPV parallel test,Pap-HPV serial test,Pap-HPV serial test was 0.788,0.840,0.910,0.917,0.916,0.782,0.832,respectively. The ROC of Pap-HPV parallel test was the highest.The cost-effectiveness ratio of Pap- HPV parallel test was best test. Conclusion: The Pap- HPV parallel screening test is best apply prospect in the study for Shenzhen women cervical cancer screening.更多还原